In spite of the controversy caused by this claim, medical insurance companies unhappy at the prospect of paying upwards of £20,000 for long term antibiotic treatment seized upon it as 'proof' from a reliable source that patients who claimed to have the disease, but who could produce no measurable antibodies, were frauds.

Just before the Steere et al. paper appeared at the Fifth International Conference on Lyme Borreliosis, it was revealed that organisers had tried to remove certain study abstracts from the conference pack because they allegedly lacked 'scientific merit'. These abstracts were, not surprisingly, those which challenged the prevailing view that Lyme disease is easily diagnosed and treated. Pressure from patient groups reinstated the abstracts (Science, 1992; 257: 1384, 1845).

The offending abstracts showed, for example, that researchers had recovered spirochaetes from patients who had undergone long term antibiotic therapy (Liegner K et al. Abstract 63; Masters E et al. Abstract 65; Fifth International Conference on Lyme Borreliosis, 1992). They also showed that B. burgdorferi can persist in human endothelial cells of the heart, lungs, blood and lymph vessels (Infect Immun, 1991; 59: 671) and fibro blasts (connective tissue cells) where they are not affected by immune responses thus explaining why infected patients don't always produce antibodies to the spirochaetes.

Despite the impression given by the medical board that Dr Burrascano is practising some kind of hocus pocus, Burrascano's own guidelines for the diagnosis and treatment of Lyme are rigourous, and viewed by many as both innovative and practical. His guidelines also emphasise aspects of medical care that have often fallen by the wayside, such as thorough history taking, physical and mental examination, individualised treatment and compassion.

Nevertheless, treating severe or chronic Lyme disease with long term antibiotics remains controversial and may have devastating consequences for patients. On the other hand, those given long term treatment have often run out of options so, for them, the risk is worth the possibility of cure. Many patients swear they get better with treatment according to Dr Burrascano's guidelines, but there are failures as well.

Also relevant is the fact that, while some blood tests may reveal the presence of antibodies to spirochaetes, there is no test to demonstrate 'cure' of the disease. Thus, it is impossible to know for certain if the patient is rid of the bacteria or simply in remission (J Am Med Assoc, 1993; 270: 2682-3).

It is well known that B. burgdorferi can be cultured from the skin or CSF of patients who have had conventional antibiotic treatment and 'cured' (Infection, 1989; 17: 355). Even after long term treatment, cure is not guaranteed. One study demonstrated that B. burgdorferi was grown from CSF after 21 days of parenteral cefotaxime and four months of minocyline (J Clin Microbiol, 1993; 31: 1961-3).

To reconcile these discrepancies, conventional medicine has invented a new disease post Lyme syndrome. Post Lyme syndrome explains away persistent symptoms by suggesting that the causal spirochaete has somehow permanently damaged the body. Some scientists say the disease is probably a form of fibromyalgia for which nothing can be done.

Post Lyme syndrome, however, is not an acknowledged medical condition. It is simply a convenient tag used by some to explain away treatment failures.

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